go back

South Dakota rates for HCPCS 25920

Disarticulation Through Wrist

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$735.91 / $735.91 / $735.91
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$617.11 / $735.91 / $1,745.70
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,276.00 / $1,661.04 / $2,076.30
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$920.93 / $1,199.27 / $1,812.24
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$685.24 / $1,420.71 / $5,425.44
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,041.97 / $1,625.90 / $2,282.77
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,041.97 / $1,444.99 / $1,961.68
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$860.04 / $1,182.75 / $1,445.17
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5,357.00 / $5,357.00 / $5,357.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$744.18 / $1,420.71 / $1,982.91
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,433.70 / $1,754.10 / $1,754.10